There are very few therapies available for brain tumor patients. One type of chemotherapy, temozolomide (Temodar) is a widely used treatment, and often the standard of care, for many patients with malignant brain tumors. Temozolomide is almost exclusively prescribed orally, and there are few (and sometime no) alternative therapies.
- Many health insurance plans cover temozolomide as a pharmacy benefit and not as a medical benefit, as traditional IV chemotherapy is covered. The result can be high co-pays or co-insurance in the hundreds or even thousands of extra dollars per month.
- An increasing number of brain tumor patients are reporting that they cannot afford the out-of-pocket costs per month to access temozolomide, yet they must take this medicine as part of their oncologist-prescribed brain tumor treatment.
- For many brain tumor patients there is not an IV chemotherapy substitute. Thus, health insurance cost-sharing can create real economic hardships and present a barrier to the affordability of a medically necessary chemotherapy regimen.
- Additionally, research has found that more than 25 percent of all anticancer agents currently in development are planned as oral drugs. Many of these new oral drugs have shown significant clinical advantages over traditional IV/injected forms of cancer treatment in early trials. As new treatments come into the marketplace, the lack of oral chemotherapy parity will become an even larger problem, both for patients as well as the pharmaceutical industry.
Congress should support oral chemotherapy parity legislation.
The Cancer Drug Coverage Parity Act, S. 1566 (Kirk/Franken), H.R.2739 (Lance/Higgins), require private health plans to cover oral chemotherapy on an equal basis as chemotherapy given through hospital administered IV or injection. Because it will only apply to health plans that already cover chemotherapy, this is not a mandate.
Not only is access to oral chemotherapy critical to proper care, it can be beneficial to the patient’s quality of life because he or she can undergo treatment at home instead of traveling to a hospital.
Health insurance should facilitate brain tumor treatment, and not create a financial barrier to it.